Course Overview: Surgery

Surgery

Learn everything about surgery online!

Surgery is a major part of your medical exams as well as daily practice. Follow your tutor Kevin Pei as he explains fundamental high–yield facts you are required to understand to become an excellent doctor.

Dr. Kevin Pei is a Board certified assistant Professor of General Surgery and Trauma at Yale New Haven Hospital and also the winner of the C Elton Cahow Teaching Award in 2015. He will review the diagnosis establishment, disease mechanisms, initial steps in management, causes, pathogens and prevention in terms of Step 2 and the Surgery Shelf exam.

This course covers the following:

General Surgery

Trauma

Sepsis

Special Surgery

Don't miss out on the chance to deepen your knowledge of these essential concepts with the help of a specialist in this field. Lecturio also provides you with downloadable material, clinical pearls and valuable mnemonics, so any fears concerning the exam questions will disappear.

Stop worrying about the right preparation now and start studying with Lecturio!

Content

Pulmonary embolism (PE) is a fatal clinical condition that occurs as a result of mechanical obstruction of the pulmonary artery or its branches by any material (such as thrombus, air or fat) from anywhere in the body. Pulmonary embolism can be an acute condition, in which the signs and symptoms develop immediately after the event (i.e., the obstruction of the pulmonary vessels), or it can be chronic, in which the signs and symptoms develop progressively for years. In this article, you will be able to understand the definition, incidence, pathophysiology, risk factors, symptoms and signs and the prognosis of pulmonary embolism.

Fluid balance is a carefully regulated system with many mechanisms to monitor and modify the absorption and secretion of water. Water is in constant motion between compartments that make up the body. When the body senses a drop in the effective circulating volume it stimulates a response to restore blood pressure and retain fluids. When there is too much fluid the body increases secretion and excretion of the excess.

Disorders of the digestive tract may result in gastrointestinal bleeding. The blood is not always visible in the stool or vomit; however, it may result in tarry black stools. Bleeding can be life-threatening in some cases. Identifying the source of bleeding is not always easy, especially if its origin is in the small intestines.

The inspiration of oxygen and expiration of carbon dioxide are vital functions of the human body. A decrease in PO2 and increase in PCO2 can alter many normal physiologic processes, and may eventually be fatal. The human body has various reflex mechanisms to manage such changes. Understanding of these reflexes and identification and management of any impairment in them is essential in the management of many respiratory and renal diseases.

The carcinoid syndrome describes the signs and symptoms associated with unregulated vasoactive hormone production by neuroendocrine tumors. Carcinoid tumors can be found anywhere throughout the body, but these will not result in carcinoid syndrome unless they form in the liver as a primary tumor or as a metastasis. Symptoms of carcinoid syndrome include flushing, diarrhea, and wheezing. VIPomas usually form in the pancreas and release vasoactive intestinal peptide (VIP) which results in profound chronic diarrhea with concomitant hypokalemia and dehydration, wheezing, and flushing (similar to carcinoid syndrome). VIPomas are often associated with multiple endocrine neoplasia type 1 (MENI). Diagnosis is based off blood or urine measurements of serotonin and VIP. Treatment consists of minimizing symptoms with medication and complete surgical removal of the tumor.

Ventricular tachyarrhythmias are a group of arrhythmias that result in a heartbeat greater than 100 beats per minute and originate anywhere in the ventricle. There are three main types of ventricular tachyarrhythmias: ventricular fibrillation, monomorphic ventricular tachycardia, and polymorphic ventricular tachycardia. Each one is associated with a high mortality rate. Symptoms include chest pain, palpations, hemodynamic collapse, and end-organ damage. If the ventricular tachyarrhythmia is suspected, start advanced cardiac life support measures immediately.

Colorectal cancer originates from the colon and rectum in the body. It is a very common type of cancer in the United States. The molecular pathogenesis of colorectal cancer involves complex pathways. There are different types of colonic polyps associated with colorectal cancer; mostly are precancerous in nature. In this article, different pathological mechanisms, colonic polyps, symptoms, diagnostic tests, treatment and prognosis of colorectal cancer will be discussed in detail.

Myocardial infarction is one of the most common causes of death in industrialized countries and requires immediate intervention, according to the principle “Time is Muscle”. 40 % of all patients die before their first post-infarction day, and 50 % die in the first four weeks. Early detection and swift action are of crucial significance, especially in the case of ST-segment elevation myocardial infarction.

Diverticulosis (diverticular disease) is an extremely common disease of the colon. The colonic wall is exposed to high luminal pressure which forces the wall outwards to form outpouchings called diverticula. This is a painless condition, but patients can become very worried as it can cause rectal bleeding. This condition is very prevalent in Western society because of the low fiber diet. Diverticulitis is a much more serious condition and occurs when a diverticula becomes inflamed. It is related to diverticulosis as the diverticula in this disease can become obstructed and/or inflamed due to an infection. The outpouching becomes very painful due to the inflammatory response and can continue to grow in size. If the outpouching is not treated rapidly, it can progress to rupture and lead to peritonitis, sepsis and death.

If diagnosed and treated in time, a patient with esophageal carcinoma can be cured. However, the symptoms are often non-specific and only appear once the tumor is already advanced. Therefore, it is all the more important not to overlook any relevant indications in clinical practice. Questions about esophageal carcinoma occasionally come up in exams, especially on etiology and clinical symptoms. Therefore, it pays to read on to learn more!

Thyroid cancer is an uncommon cancer that can be managed well if detected early enough. It arises from follicular or parafollicular cells within the thyroid. There are subtypes of cancer depending on the cell involved and the mutations that occur. The most common cure for this cancer is surgical removal of the thyroid, along with chemotherapy or radiotherapy.

Over the past several years, more and more individuals attract malignant gastric cancer. In many cases, however, the initial symptoms of the disease are so non-specific that the tumor is not diagnosed until it is in an advanced stage, resulting in the prognosis being worse. Which risk factors promote the development of gastric cancer, and what are the treatment options once the diagnosis of gastric carcinoma has been made? In the following article, you will find out everything you need to know about gastric cancer.

Abdominal Aortic aneurysm results from loss of strength and thinning of the aortic wall. It often implies the threat of rupture of aneurysm demanding of emergency interventions. Being asymptomatic, delayed discovery of AAA is a common phenomenon. The exact etiology of AAA is not known. Males develop AAA more commonly than females. The risk factors of AAA involves hyperlipidemia, hypertension, heart disease, smoking and family history. With the proper evolution of the case, elective surgical repair can be opted as definite cure.

Peripheral artery disease, shortly referred to as PAD, is a condition caused due to atherosclerosis. Estimated to be affecting around 200 million people in 2010, the intermittent claudication is a medical entity of rising impact, which every prospective physician should master. The underlying atherosclerosis is not only the most common arterial vascular disease but also the pathologic substrate for many other common and often life-threatening diseases. These include strokes, heart attacks or aneurysms—comorbidities and risks, which can first manifest as PAD. This article´s purpose is to illustrate how PAD is diagnosed and treated as well as to provide exam-oriented information.

Achalasia (cardiospasm) is a functional disorder caused by narrow position of lower esophageal muscles. It is marked by reduced or absent peristaltic movement of esophagus and relaxed lower esophageal sphincterat swallowing. This abnormality result in functional obstruction at the junction of esophagus and stomach with symptoms such as dysphagia, regurgitation, heartburn, stomach pain and weight loss. It is diagnosed by the help of barium swallow, esophageal monitoring and endoscopy. Pharmacological and non-surgical interventions are adopted to treat achalasia.

As mammary carcinoma is the most frequent malignant disease in women, early detection is important. There are numerous diagnostic tools available, the mammogram being the gold standard. The next step would be developing a treatment plan that is individualized for the patient and the type of carcinoma. The following article will teach you to accurately diagnose mammary carcinoma and to initiate the appropriate therapy.

In this article, you get an overview of the pathology of the brachial nerves and understand how a hand of benediction or a median claw hand, an ulnar claw and a hand extension loss with the radial nerve paralysis may develop.

Breast cancer (mastocarcinoma) is the most common form of cancer among women. Consequently, it will be encountered by doctors as part of their work in hospitals and medical practice. This disease exhibits a heterogeneous pattern including different histological subtypes, which may differ considerably in their degree of malignity and, consequently, in their clinical symptoms and therapy. The following article helps you to understand the clinical picture of mastocarcinoma, identify its symptoms and to classify its histology correctly.

The multiple endocrine syndromes are inherited autosomal dominantly and consist of two superior groups (I and II). The second group can be further divided into three subgroups (IIa, IIb and FMTC-only). The respective upper groups have different causes on moleculargenetic level. Characteristic signature diseases i.a. appear as part of these syndromes.

Gallstones are common in the United States, especially among the Hispanic population. They are common among the fatty fertile females in their forties. The gallstones are mostly asymptomatic that do not need treatment except in certain high-risk groups. The symptomatic patients present with right upper quadrant abdominal pain and cholecystectomy is the primary treatment option in these patients.

Gastroesophageal reflux disease and its complications, particularly Barrett’s esophagus, is a much favored exam topic. Due to its high prevalence amongst the west industrial countries and its increasing incidence, medical students are expected to come across symptoms associated with this condition all the more often in daily clinical practice. That is why you should definitely be well-prepared for such an occasion.

Pediatric gastrointestinal disturbances are common, often simple to manage and yet, unfortunately, life threatening in some instances. Sometimes, seemingly innocuous vomiting can be a harbinger of a serious underlying disease. This article expounds on various patho-physiological aspects of pediatric vomiting and diarrhea, and expatiates on the rapid aggressive treatment of accompanying dehydration.

Fibroadenomas are benign breast tumors that arise in young women. Histological examination of these lesions usually reveals lobular hyperplasia. Known risk factors for breast cancer, such as early age of menarche or nulliparity, do not increase the risk of fibroadenomas. The diagnosis of fibroadenomas is based on the physical finding of a mobile, non-tender breast mass, that is slightly hypoechoic on ultrasonography and that has cell clusters in fine needle aspiration. Fibroadenomas that are asymptomatic and small in size should be treated conservatively, while ones that are growing rapidly in size and are symptomatic should be surgically excised.

Testicular torsion is the most common cause of acute testicular and scrotal emergency pain. Patients usually have unilateral testicular torsion and the most common etiology is a high abnormal attachment of the tunica vaginalis. Abnormal attachment of the tunica vaginalis results in spermatic cord increased mobility and predisposes to spermatic cord twisting and subsequent testicular torsion. Testicular infarction and necrosis can ensue if the testis is not detwisted in the first 8 hours and is usually complete by 24 hours of torsion onset. Bilateral testicular fixation to the tunica vaginalis is recommended.

Non-invasive breast cancer can be either ductal carcinoma in situ or less commonly lobular carcinoma in situ. Ductal carcinoma in situ is of epithelial type, and there is usually no basement membrane invasiveness. Because of the lack of invasiveness, these tumors are unlikely to metastasize by the lymphatics or blood vessels. Ductal carcinoma in situ is usually diagnosed by a mammography and not by physical examination. Microcalcifications on mammography are the most common presenting feature. Local excision of the lesion is recommended to obtain histopathologic data and guide treatment. Total mastectomy or breast conservation therapy are the two options for the treatment of ductal carcinoma in situ.

Pyloric stenosis, also known as infantile hypertrophic pyloric stenosis (IHPS), is a condition that is characterized by pyloric muscle hypertrophy and hyperplasia, which leads to gastric outlet obstruction. Infants usually present in their third week of life with repeated, projectile vomiting, that is often associated by an abdominal olive-like palpable mass. The clinical picture is usually enough to make the diagnosis, but ultrasonography can help confirm the diagnosis of pyloric stenosis in most of the patients. Surgical correction with pyloromyotomy is the treatment of choice.

Intussusception occurs when a distal segment of bowel telescopes into the lumen of proximal bowel. This can happen at any age, but is most common in infants between three and eighteen months. It is the most common cause of bowel obstruction in three months of age to six year old children. This article gives you brief information about the epidemiology, etiology, pathology, signs and symptoms, diagnosis and treatment of pediatric intussusception.

Primary sclerosing cholangitis is a common cause of chronic liver disease in patients with ulcerative colitis. It is an autoimmune disorder and patients usually present with jaundice, fever, abdominal pain and elevated alkaline phosphatase. Endoscopic retrograde cholangiopancreatography is the best diagnostic tool to confirm the diagnosis of primary sclerosing cholangitis. Multiple strictures and dilations of the biliary system is usually observed. Symptomatic treatment, immunosuppression and ursodeoxycholic acid are used in early stage PSC. In later stages, liver transplantation might be the only option available to alter prognosis and survival.

Pancreatic pseudocysts are a complication of acute pancreatitis, and they are more common when the etiology is alcohol-related. These pseudocysts do not have an epithelial wall, and their fluid content is rich in amylase, lipase and trypsin. Abdominal CT scan is the diagnostic modality of choice to confirm the diagnosis of pancreatic pseudocysts and exclude complications. MRI or ERCP can be used to assess communication between the pseudocyst and the pancreatic duct, and if present, transpapillary drainage of the pseudocyst can be attempted.

The spinal cord is the continuation of the brain stem medulla below the foramen magnum. This article discusses lesions and diseases of the spinal cord, highlighting the Brown-Sequard syndrome and Tabes Dorsalis.

Temporal arteritis, also known as giant cell arteritis (GCA), is the vasculitis of the superficial temporal artery. Inflammation of the vessel wall produces systemic, neurologic and ophthalmologic signs and symptoms.
Carotid artery disease, also called carotid artery stenosis, is the narrowing of the lumen of the carotid arteries due to fats and cholesterol deposition (plaque). The complete blockage of the artery, called carotid artery occlusion, can lead to cerebral ischemia and stroke.

The lung is the major organ of the respiratory system and used to inhale oxygen and remove the metabolic waste in the form of CO2 from the body. Malfunctioning of the lungs can lead to serious complications and disturbs the normal living conditions. Lung cancer is one of the severe conditions which have a relatively high mortality risk. Previously, it was the leading cause of death among men in more than 25 developed countries. Now it has become a worldwide cause of death among men. Most common cause of lung cancer is smoking, especially in men. Prognosis of this condition is still poor for malignant tumors. Read everything important about it here.

Liver tumors are some of the more common neoplasms and are classified as either primary or secondary. Management varies depending on several factors such as type, size, and the spread of the cancer. Continue to read this article to learn key facts about the tumors of the liver including incidence, pathology, clinical features, diagnosis, and treatment.

Can you master the differences between the axial and paraesophageal hiatal hernia? How do the patients present clinically? And when is surgery indicated? This and all other relevant test content about this topic can be found in this article.

Abdominal and Pelvic traumas is characterized by disturbance or penetration of abdominal wall and its contents by blunt or gunshot injuries. The signs and symptoms depends on the type injury impacted on the abdomen with or without penetration of the weapon, the range of injury, organs that are traumatized and the position and quantity of wounds formed. After physical examination of the injuries with survey of the vital signs, level of consciousness, loss of blood, immediate surgical intervention becomes necessary to stabilize the patient.

This article provides a brief overview of neurotrauma, its classification and differential diagnosis, diagnosis and management. Neurotrauma is a common presentation in emergency departments across the world and is often an emergency situation. Patients who are not diagnosed and treated promptly can quickly succumb to comas and often irreversible damage or death. As such, a familiarity with each clinical diagnosis is needed and this article should provide the basis for that. We look at traumatic brain injuries (causing concussions, contusions and diffuse axonal injuries) along with bleed disorders like epidural hematomas, intraparenchymal hemorrhage, subdural and subarachnoid hemorrhages. A basic definition, pathophysiology and etiology is provided for each.

Neoplasms of the skin can be hard to differentiate clinically, but nevertheless they can result in entirely different consequences. While the colloquially called “white skin cancer” describes rather harmless changes of the skin, the “black skin” cancer is feared. As other doctors from different specialties, other than dermatologist, are also consulted when discussing diagnostic findings of their patients’ skins, it pays off to know the most common types of skin cancer.

Harbingers of summer, the first rays of sun are tempting us to go outside. Temperatures are still moderate but with a rising thermometer value, one should keep in mind the dangers that result from heat exposure over a long time. Thermic emergencies are often underestimated; however, they can be lethal. Burns and electric shocks also damage the tissue through heat. Learn more about these three types of thermic injury and how to act in case of an emergency.

Acute abdomen is considered an emergency that characterized by sudden and severely tender abdominal pain. It is usually associated with life-threatening medical conditions that prompt urgent diagnosis and management. Differential diagnoses should be ruled out with physical examination, laboratory tests, and different imaging modalities. Management is based on the underlying etiology through either medical treatment or surgical intervention.

Appendicitis is a common and serious gastrointestinal disease that affects many people every year. It can be very acute and painful and, if it is not treated quickly, it can be fatal. We will explore the mechanics behind appendicitis; the causes, treatments and complications that can arise. Appendicitis is commonly examined as it is fairly prevalent, acute and can be very serious.

The systemic inflammatory response syndrome is an acute inflammatory pathology with a systemic body reaction. Triggers include traumata, big operations, inflammations or, for example, infections. If pathological germs get from one source of infection into the bloodstream, a sepsis or blood poisoning occurs. Sepsis and septic shock are the main causes of death on the Intensive Care Unit.

There are two types of catecholamine secreting tumors: pheochromocytomas which arise from the chromaffin cells of the adrenal medulla and paragangliomas which arise from the sympathetic ganglia or other cells derived from the neural crest. Catecholamines include epinephrine and norepinephrine, and both are released upon the stimulation of the sympathetic preganglionic nerve fibers during times of stress or sympathetic activation.

Pancreatic cancer is one of the most aggressive malignant tumors worldwide. It is considered the 4th cause of overall cancer mortality among cancer patients. 5-year survival rate for stage 1A pancreatic cancer patients is less than 15%. Patients usually have vague complaints leading to late presentation and early metastasis which contribute to the high mortality rate. Tumors of the pancreas can arise from the exocrine part, mainly the duct system, which is the most common, or arise from the endocrine islet cells (neuroendocrine tumors) which are less common. Most of the pancreatic tumors arise in the head or neck of the pancreas with less frequent tumors arising from the body and tail.

Conus medullaris and cauda equina syndromes are spinal cord injuries that involve injury to the lumbosacral segment of the spinal cord. They are majorly due to traumatic events and present with features of lower motor neuron and upper motor neuron lesions involving the bladder, bowel, nearby skin and muscles.

The esophagus can be injured by blunt or penetrating traumatic injuries. These type of injuries are rare, but they still life-threatening conditions. Most causes of esophageal injuries are considered iatrogenic, but may be spontaneous or traumatic. Rapid diagnosis and management provides the best chance for the patient to live without disabilities. However, delayed diagnosis is common, leading to increasing morbidity and mortality. In this article, we will discuss the pathophysiology, etiology, investigations, and management for this potentially fatal gastrointestinal condition.

The intestine is part of the GI tract responsible for food digestion and absorption. The large surface area of the intestinal wall formed by villi, plicae and valvulae is responsible for the absorption of water, minerals, vitamins and all nutritional components. The small intestine is more vulnerable to obstruction for many reasons including the length, diameter and location. Intestinal obstruction can be actual mechanical obstruction or compression and can be functional paralysis of the hollow muscular organ. The most common cause of obstruction is external adhesions following abdominal surgical interventions and obstruction complicating hernias. Bowel obstruction is sometimes partial chronic obstruction due to adhesions, irradiation and Crohn's disease causing strictures or intestinal wall neoplasm or polyp.

Traumatic injuries are one of major causes of high morbidity and mortality nowadays. Traffic accidents, sports related and violence-induced traumas often include thoracic trauma. Different classification and scoring systems are available, all made with the same goal: recognition of signs and symptoms, rapid primary assessment, timely and to the point diagnostic procedures, proper treatment and all leading to the same point which is a lesser time to recover and a favorable outcome.

Traumatic injuries due to traffic accidents, sports or violence induced incidents, represent one of the major causes of morbidity and mortality nowadays. Significant portion of all trauma cases include head trauma, which can be divided into fractures, brain traumatic injuries, hematomas (both extra axial and parenchymal) and diffuse axonal injuries (DAI). Recognition of the signs and symptoms is of uttermost importance, for head trauma can be as mild as every day bruises and bumps to the head, or severe and life threatening. Rapid recognition, dedicated diagnosis and adequate imaging which lead to proper treatment - both conservative and surgical - are essential for the best possible, complication- and sequel-free, outcome.

This article provides a clinical run through increased intracranial pressure for the USMLE step 2 examination. It defines raised ICP, goes through its pathophysiology, progression and special forms, diagnosis, differential diagnosis and treatment (management, including patient monitoring). References for the work are included at the bottom.

Injuries in the urinary bladder and urethra by any trauma are uncommon. The damage and rupture in these organs may occur as a consequence of blunt or penetrating trauma to the pelvis and abdomen. Only a few number of pelvic fractures lead to urinary bladder ruptures. The severity of bladder ruptures depends upon how much of the bladder was full during the time of injury and cause/causes of that injury. In earlier days, the diagnosis of urinary bladder and urethra injury was often missed or delayed due to the lack of proper knowledge and adequate medical instruments. The early diagnosis and proper treatment successfully help patients to avoid several complications.

Thoracic traumatic injuries can be generally classified according to the mechanism of injury as blunt or penetrating chest injuries. Chest injuries can be also classified according to the site of injury as chest wall, lung, heart, major blood vessel, and esophageal injuries. The extent and specific type of thoracic traumatic injury can be identified by a proper history and physical examination that is supported by adequate imaging studies. The treatment includes fluid therapy and oxygen supplementation in addition to specific treatments depending on the specific type of injury.

Acute pancreatitis is an inflammatory process of the pancreatic tissue with cellular destruction and elevation of serum pancreatic enzymes. The mortality of acute pancreatitis is high specially with necrotizing and infective pancreatitis due to multisystem organ failure. It is the most common cause of gastrointestinal hospitalization in the United States.

The urinary system consists of the kidneys, ureters, urinary bladder, prostate, and testes; however, the collective term urologic cancers usually refer to the carcinoma of the urinary bladder and the prostate. The urinary bladder is a hollow organ that is used to store urine before its excretion. When urine is produced from the kidneys, it is supposed to go down the ureters and to reach the urinary bladder via the two ureter orifices. The urinary bladder is composed of an inner layer that is lined with urothelial and mucosal cells, a lamina propria layer that is mainly connective tissue, and a third layer that contains smooth muscle.

Rotator cuff injuries can occur in older and younger adults. These injuries can range from tendinitis to complete tears of one of the rotator cuff tendons and muscles. Rotator cuff injuries can occur due to repetitive overhead activities, direct trauma to the shoulder, or senile degeneration of the tendons of the rotator cuff. Magnetic resonance imaging is the most accurate imaging modality for the visualization of the rotator cuff muscles. The goal of the management plan is to make the patient independent, and completely pain-free with a full range of motion, and surgical treatment as the last option.

Intestinal malrotation is a congenital abnormality that is characterized by the abnormal position of the bowel within the peritoneal cavity due to incomplete rotation and abnormal fixation of the intestine to the abdominal wall. Almost all cases of intestinal malrotation are diagnosed within the first year of life. The main presentation of intestinal malrotation is bilious vomiting and abdominal distension. Midgut volvulus is a life-threatening complication of intestinal malrotation that should be diagnosed early and treated properly to avoid sepsis and mortality.

Bones constitute the supportive skeleton of the body. They are composed of an organic component of type-1 collagen with calcium, phosphate and hydroxyl ions deposited in hydroxyapatite. Bones are covered with a thin layer of periosteum which provides blood supply to help the healing of bone fractures. Bone fractures are the result of damage to the integrity of normal bones due to direct force or pathological processes.

Colorectal cancer is the third most common cancer affecting the human being. It can be called as polyp-cancer sequence. Colorectal cancer is believed to occur secondary to the transformation of the mucosal epithelial cells characterized by rapid turnover. The mucosal cells protrude into the lumen as polyps which might transform into a dysplastic and invasive lesion. Adenomatous polyps are the most common colon polyps associated with malignant transformation. Herein, we will discuss the different types of colon polyps and genetic basis for colorectal cancer transformation and overview of the management strategies.

Hypokalemia is defined as plasma potassium less than 3.5mEq/L. Only 1 % of the general population suffers from this disorder with the prevalence rising to 25 % among hospitalized patients. Some risk factors of hypokalemia include elderly patients and people who rely on food poor in potassium content, women and patients recovering from bariatric surgery.

Hyperkalemia is defined by the serum potassium level when it is higher than 5.5mEq/L. It is usually an incidental finding in the general population but affects 10 % of the hospitalized patients. Severe hyperkalemia is rare but catastrophic as it causes respiratory paralysis, generalized muscle paralysis and cardiac arrest.

A femoral neck fracture is associated with high morbidity and mortality. Up to 30% of patients die in the first year following the fracture. It is more common in elderly women. The head and neck are enclosed in the joint capsule within the synovial fluid. No intracapsular callus formation upon fracture, and no periosteal layer which affects the healing process.

Necrotizing enterocolitis is a life-threatening inflammatory condition of the bowel that is characterized by mucosal injury, bowel necrosis or perforation. The condition is more common in pre-term infants. Bowel ischemia is believed to play a key role in the pathology of the condition, especially in full-term infants.

The right recurrent laryngeal nerve arises from the right vagus nerve at the level of the innominate artery where it loops around the subclavian artery. The nerve then travels along the pleura to the tracheoesophageal groove between the trachea and esophagus. The left recurrent laryngeal nerve has a longer course arising from the left vagus and then loops around the aortic arch and ligamentum arteriosum to ascend parallel to the left tracheoesophageal groove.

Your Educators of course Surgery

Kevin Pei, MD

Dr. Kevin Pei is Assistant Professor of Surgery at Yale School of Medicine, Associate Director of Surgery Clerkships and Associate Director of Resident Education at the Yale Center for Medical Simulation. He is passionate about curriculum development and improving patient outcomes through creative education and simulation.

User reviews

(49)
4,4 of 5 stars

5 Stars

31

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Excellent!

By Ginger T. on 30. October 2018 for The Acute Abdomen – General Principles

Very simple and straightforward. Excellent use of the films to show each case - best example I've seen thus far. I always struggle with the radiology terms used in materials, especially if the accompanying graphic isn't clear.

I didn't like it

By Onsi N. on 25. October 2018 for Surgery

I didn't like it att all because its Very poor and brief. It doesn't include orthopedics

By Ginger T. on 30. October 2018 for The Acute Abdomen – General Principles

Very simple and straightforward. Excellent use of the films to show each case - best example I've seen thus far. I always struggle with the radiology terms used in materials, especially if the accompanying graphic isn't clear.

I didn't like it

By Onsi N. on 25. October 2018 for Surgery

I didn't like it att all because its Very poor and brief. It doesn't include orthopedics

Great

By Miziel R. on 14. October 2018 for Hyperkalemia and Hypokalemia

clear and confident knows his stuff. hope he lectures more.

detail

By Qiming D. on 02. October 2018 for Acute Abdomen: Appendicitis

we need more details for preparing of the USMLE step2 CK.

Like it very much!

By Mariella N. on 03. September 2018 for The Acute Abdomen – General Principles

It is perfectly explained, included important facts med students need to learn! Congratulations

Carpal Tunnel Syndrome

By Marcio M. on 30. August 2018 for Carpal Tunnel Syndrome: Management

I liked it very much, he is calm and very interested on making you understand :)

Indications of necrosectomy and empiric antibiotic therapy

By Miguel L. on 12. June 2018 for Pancreatitis: Diagnosis & Management

YOU DO NECROSECTOMY ONLY IN CASES OF INFECTED NECROSIS AFTER 4 WEEKS OF ADMISSION

Simple but detailed

By Rabi E. on 01. June 2018 for General Surgery

The lectures are simply delivered but detailed. And the review questions are very helpful.

Great!

By Areli T. on 28. May 2018 for Burns

Great lecture, it has everything you need to know, very well explained, you can understand everything very fast with no doubt

nice teaching

By Ebtsam S. on 30. April 2018 for Trauma: Initial Survey and Management

liked it very much , and I can not wait to learn more

very informative concise course , more details will make it supercool

By Osama A. on 27. April 2018 for Surgery

very informative concise course , more details will make it supercool

Thank you!!

By Vanessa T. on 29. March 2018 for Sepsis: Management

Very informative, now i understand the management very well . I really enjoyed this lecture!

cool,calm and nice.

By Iftakhar A. on 06. March 2018 for The Acute Abdomen – General Principles

His lecture is very cool mood.so My Brain can catch his speech easily.Hope these lectures will help me in my examination.

Excellent teacher

By Sara R. on 18. February 2018 for General Surgery

His way of teaching is excellent. His calm voice and to the point lecutures are amazing to learn from.

Excellent

By Rodrigo C. on 12. February 2018 for Burns

Very well explained all the most important points. Would be nice to see more photos.

Thanks!

By Soudeh P. on 03. February 2018 for Sepsis: Management

Dr Pei talkes is a good speaker. I enjoy his lectures. You talk very clear and not to fast. Great to listening to.

Very good

By Rodrigo C. on 11. January 2018 for Small Bowel: Carcinoid

Very well explained. Nice questions too. Yet I prefer when all the disease is on the same video.

Questions

By Rodrigo C. on 08. January 2018 for Inguinal and Femoral Hernias

Need a few questions to make sure we learned what is important.

Great

By Rodrigo C. on 08. January 2018 for Hernia: Introduction

Very clear and concise explanation. But, could have more questions.

Proper way of accuracy in his presentation on a most complicated topic. It is easily understandable though it is very tuff one

By Dvsvb R. on 29. November 2017 for Thyroid Cancer

Clarity and accuracy of his making all adds in the topic a simple easily understading one is a best example hidden in his lecture. A clear understanding of a complicated study could be possible even for avarage inteligent reader. 2nd thing is illustrations in every aspect made it highly comprehencive and brief

thanks for your effort

By Madkour M. on 24. November 2017 for General Surgery

still superficial , not deep in surgery subject , need more details

A clear study with good concept

By Dvsvb R. on 23. November 2017 for Inguinal and Femoral Hernias

It is an impartant topic and is explained well..
Grate work shown in it in all aspects

Proper way of accuracy with good content

By Dvsvb R. on 23. November 2017 for Appendicitis: Diagnosis and Management

An excellent lecture.
Everything is clear to understand. And to learn
Thank you

Proper way of accuracy with good content

By Dvsvb R. on 23. November 2017 for Acute Abdomen: Appendicitis

Every thing is good .
Signs and symptoms exactly present in100 persent cases.
Very sseful

Dukes Astler Classification not mentioned

By Scott . on 17. November 2017 for Colon Cancer: Diagnosis and Management

very well explained but what about dukes astler classification for tumor penetration and linfatic afectation.

It 's quite interesting!!!!!

By James A. on 03. November 2017 for Special Surgery

When you see the time of videos you said it 's too little but miraculously you can answer a lot of questions about this content.If you want deep learning you must definitely read the article.With the video only will save you your life for an exam.

Great Lecture!

By Jakob R. on 02. November 2017 for Sepsis: Management

Clear, encompassing definition of sepsis management.
Maybe a little section on the specific doses of medications when talking about initial hemodynamic stabilization would be a good idea.

To basic

By Santiago A. on 18. October 2017 for Hydrocephalus: Diagnosis and Management

Very little information is given, I understand lectures need to be easy and contain important information but this is a summary of a summary

Good way to study surgery.

By James A. on 30. September 2017 for General Surgery

Thank you Dr Pei!!! i like the organization of the slides and everything is explained very well.

orthopedics is by fare not complete !!

By jii l. on 30. September 2017 for Classic Fractures

I think overall orthopedic section is lacking. There are a lot of subjects not covered! I like the lecturio concept but i think they need to make the courses more complete and a little more in debth so that it can be really helpfull for medical school.

With a lot practical example!!!

By James A. on 30. September 2017 for Surgery: Trauma

Very good information that can make any medical student save life in the emergency room as well get a good score for the exam.

Awesome.

By Ugochukwu A. on 03. August 2017 for General Surgery

Many thanks Dr. Pei. I appreciate your lectures. They were precise.

Covers what you need to know in details within a short time

By Blessing M. on 23. June 2017 for General Surgery

Well organised material, cover most salient points within a short time.

Incomplete.

By Tausiful H. on 14. June 2017 for Classic Fractures

The video repeats itself midway through. If that was the entire content then this is very superficial.

General surgery

By Yada C. on 16. May 2017 for General Surgery

These lectures help me recall the lessons and give me very useful clinical pearls

VERY GOOD

By Abby R. on 14. April 2017 for Ventral and Incarcerated Hernias

much more details on the diagnosis could have been provided....on the whole I really pleased to find a website like this....please continue to develop the site...its really good

Criteria for Head CT

By Hamed S. on 29. March 2017 for Traumatic Brain Injury (TBI)

I would have love to learn further about the criteria for performing a head CT eg Canadian Head CT Criteria or others that may be appropriate to guide decision for head CT

Break down of management according SA affected

By Hamed S. on 29. March 2017 for Burns

I would have loved to learn how the management of burns differs according to the SA affected. Moreover, a discussion on chemical and electrical burns would have also been fantastic

LCIS, Choice between FNA and CNB

By Hamed S. on 29. March 2017 for Malignant Breast Diseases

It would have been good to talk about LCIS as well as DCIS particular as the management differs. Also no discussion of the choice between FNAs and CNB in regards to sensitivity and specificity.

I think it would be worthwhile to also focus on upper gi bleeding as well. Also It would extremely handy to learn about working up a patients with suspected GI, ie what investigations you would do first. Toronotes Notes has a wonderful flow chart in the Gastrointestinal chapter

Nice coverage of Diverticulitis

By Hamed S. on 28. March 2017 for Diverticulitis: Management

I would have liked to also learn a bit about Hartmans procedure in emergent cases. Discussion of recurrence rates for patients undergoing conservative management

Post complications?

By Hamed S. on 28. March 2017 for Inguinal and Femoral Hernias

Good talk I would have liked the discussion to also include post operative complications as well as recurrence rates following hernia repair.

Good start but can be improved

By Hamed S. on 28. March 2017 for Acute Abdomen: Appendicitis

The introduction on appendicitis lecture was sharp and to the point. However it can be improved by a discussion of the pathophys ie children or young adult: hyperplasia of lymphoid follicles, initiated by infection, adult: fibrosis/stricture, fecolith, obstructing neoplasm and other causes: parasites, foreign body.

Great overview

By Agnes L. on 06. February 2017 for Femoral Neck Fracture

Very good overview of this topic, with highlight on serious pathology and management

Excellent videos

By Sahiba S. on 29. January 2017 for Surgery

Excellent and concise lectures, what is required for core curriculum in surgery. Looking forward to the Trauma and Critical Care series now. Many thanks.

The Lecture is awesome

By Harit W. on 26. January 2017 for Appendicitis: Diagnosis and Management

The Lecture is awesome!! It includes many crucial information needed to know in short period of time , and also the lecturer has a soft voice and the skill making the topic easily understood

we wanted

By Badir A. on 23. January 2017 for Surgery

when it finished please finish it and thank you and hope all of best

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